POONAM S PATEL OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****63

License Status

NOT RENEWED

Business

First Name

POONAM

Middle

Last Name

PATEL

Suffix

Business Name

POONAM S PATEL OD

Original Issue Date

08/17/2011

Effective Date

03/16/2012

Expiration Date

03/31/2014

City

ARLINGTON HEIGHTS

State

Zip

60004

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/06/2014